Aboriginal Health Blueprint – Engagement of Non-Aboriginal Key Stakeholders

Summary of Responses from Ontario’s Public Health Stakeholders

Public Health Division,

Ministry of Health and Long-Term Care

DRAFT - August 18, 2005

Table of Contents

Public Health Programs and Services and Aboriginal Communities in Ontariopage 1

Aboriginal Health Blueprint: Objectives and Processpage 3

Engagement of Ontario’s Public Health Stakeholders - Summarypage 5

Appendix: page 7

Memorandum to Public Health Stakeholders from the Chief Medical Officer of Health (June 16, 2005)

Public Health Programs and Services and Aboriginal Communities in Ontario

The responsibility for providing public health care to Aboriginal communities in Ontario is an extremely complex area, both historically and legally.

Historically, the federal government has taken prime responsibility for providing public health services on First Nations.

In Ontario, public health units are required to deliver programs as prescribed under the Health Protection and Promotion Act (HPPA) to all people, in every area of the province.

Aboriginal communities including those on-reserve, are covered by the HPPA:

  • Under Section 50 of the HPPA, a board of health and a Chief and Council on-reserve within the health unit may enter into an agreement whereby the board agrees to provide health programs and services to the community;
  • In this case, the Chief and Council agree to accept the financial responsibilities as if the Council was an obligated municipality; and
  • By entering into an agreement with a board of health, the Chief and Council has the right to appoint a representative to the board of health.

The Peterborough County-City Health Unit is the only health unit that has entered into such an agreement under Section 50. This agreement is with Curve Lake First Nation for the provision of mandatory health programs and services.

Informal arrangements with other public health units across Ontario also exist. For example, some local public health units:

  • Provide provincially-funded vaccines to Aboriginal persons living on-reserve (upon request), including routine immunizations, and immunization against pneumococcal disease, chicken pox, and meningococcal disease;
  • Provide BCG (Bacille Calmette-Guérin) vaccine for use on-reserve for the prevention of Tuberculosis in specific circumstances (i.e., in communities with increased rates of Tuberculosis); and
  • Provide assistance with regard to the management of communicable disease outbreaks.

Despite being a positive first step, these informal arrangements are voluntary and tend to be sporadic with no real permanence or viability.

Ontario recognizes the fiduciary responsibility of the federal government on-reserve, however the province also has an interest in ensuring that all Aboriginal people residing in Ontario have equitable access to public health services.

Aboriginal Health Blueprint:

Objectives and Process

Federal/Provincial/Territorial (F/P/T) First Ministers and leaders of five National Aboriginal Organizations (NAO) agreed to work together on a Blueprint for Aboriginal Health at a special meeting on September 13, 2004.

Aboriginal leaders, F/P/T Ministers of Health and Aboriginal Affairs were tasked to develop the Blueprint and report back to First Ministers within one year.

Ministers of Health agreed to lead the Blueprint process - Ontario and Health Canada Co-Chair the process.

The Blueprint will be one document that will include:

  • National Framework;
  • Regional Frameworks; and
  • First Nations/Inuit/Metis-specific streams.

All partners agree on and support the Blueprint outline which includes:

  • Vision, Principles; and
  • 6 Action Areas based on the September 16, 2004 communique:
  • Delivery and Access;
  • Sharing Improvements to Canadian Health Care;
  • Promoting Health and Well-Being;
  • Monitoring Progress and Learning as We Go;
  • Clarifying Roles and Responsibilities; and
  • Developing On-going Collaborative Relationships.

The Blueprint will be tabled at a Special Meeting of First Ministers and NAO in November 2005.

There are a number of national, regional, and Aboriginal-specific engagement processes currently taking place across Canada to inform the development of the Blueprint.

In Ontario, both internal and external engagements have been implemented. A meeting of internal Ministry of Health and Long-Term Care (MOHLTC) stakeholders along with representatives of other interested ministries was held on May 19, 2005, to identify the Ontario government’s interest and priorities, and an external Working Group has been established to develop the Ontario region-specific component of the Blueprint.

Emerging priorities and opportunities for public health as a result of the internal and external consultations include:

  • Promoting Health and Well-Being:

-Enhancing health promotion and disease prevention; and

-Improving public health services on-reserve (including planning for an influenza pandemic and other public health emergencies).

  • Developing On-Going Collaborative Working Relationships:

-Building on the Aboriginal Healing and Wellness Strategy model; and

-Improving intra- and inter-ministerial, and inter-jurisdictional collaboration and coordination.

Engagement of Ontario’s Public

Health Stakeholders - Summary

Subsequent to the MOHLTC engagement process for the Blueprint:

  • The Chief Medical Officer of Health (CMOH), Dr. Sheela Basrur, issued a memorandum to Medical Officers of Health and public health stakeholder organizations on June 16, 2005.
  • The CMOH requested advice and recommendations regarding the development of concrete initiatives that Ontario might wish to consider to improve the health status of Aboriginal people.

In total, 24 responses were received: 19 from the 36 public health units in Ontario, and 5 from other stakeholder organizations.

Four key questions were posed, and a summary of the responses that were received follows:

  1. What services do you currently provide for the Aboriginal people?
  • The majority of respondents (72%) indicated that they do not provide services to Aboriginal communities on-reserve, whereas all respondents indicated that their services are available to the Aboriginal population off-reserve;
  • The provision of Aboriginal-specific services is dependent upon the location of the health unit in proximity to First Nations reserves and the profile of the Aboriginal population off-reserve; and
  • The Healthy Babies Healthy Children program is often accessed by the Aboriginal population both on- and off-reserve (specific funding is available to Aboriginal people through the Aboriginal Healing and Wellness Strategy for the delivery of the Aboriginal Healthy Babies Healthy Children program. However, this program is sometimes delivered in collaboration with local health units and organizations).
  1. What do you believe are the gaps in services for the Aboriginal people?
  • Lack of Aboriginal-specific health data/information;
  • Paucity of culturally sensitive/specific resources;
  • The need to build stronger relationships, and linkages with existing Aboriginal services;
  • Lack of clarity regarding jurisdictional responsibility for the provision of public health services to Aboriginal communities on-reserve;
  • Lack of accessibility to services;
  • Lack of Aboriginal health professionals; and
  • Lack of Aboriginal services in urban and rural areas for off-reserve populations.
  1. What would you consider priorities to improve the health status of Aboriginal people in Ontario?
  • Collection of health status indicators for the Aboriginal population;
  • Culturally-specific prevention programs;
  • Increased collaboration between service providers;
  • Inclusion of elders and traditional practices when planning services; and
  • Increased consultation with the Aboriginal population.
  • Address determinants of health [i.e., housing, addictions (including tobacco, alcohol, drugs, and gambling), nutrition, etc.]
  1. What concrete initiatives could be developed and implemented that would improve the health status of the Aboriginal people through addressing the identified gaps and priorities?
  • Round table discussions;
  • More resources (staff and funding) to work with the Aboriginal community;
  • Training for health unit staff re: working with the Aboriginal population;
  • Representation of First Nations on boards of health; and
  • Alignment between jurisdictions/clarification of responsibilities.

Appendix


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